Management of Low-Grade Dysplasia in Ulcerative Colitis

The management of low-grade dysplasia (LGD) in chronic ulcerative colitis remains highly contentious. The treatment options have conventionally been either immediate colectomy or continued intensive surveillance. There are many factors that contribute to the uncertainty surrounding the management of these lesions. Conventional endoscopic surveillance and biopsy protocols are disappointing and the identification of LGD remains challenging. Additionally, it is very difficult to endoscopically distinguish dysplasia-associated lesions or masses (DALM) from the less important sporadic adenomas in patients with chronic colitis. The variable and uncertain natural history of low-grade dysplasia in colitis coupled with significant inter-observer variability in histological interpretation of the lesion even among expert pathologists adds to the confusion. Should patients with LGD be managed conservatively with intensive surveillance, endoscopic polypectomy or mucosal resection, or do all patients require early colectomy? This article will explore some of the arguments regarding the management of these highly controversial lesions in patients with chronic ulcerative colitis.